Pruritic rash with proximal muscle weakness

CHIEF COMPLAINT: Patient is a 64-year-old female who presented to the clinic with a pruritic rash that started on her left wrist and then spread to her right arm, chest, scalp, and posterior neck.

CLINICAL HISTORY:

Signs and symptoms: She denied any recent sun exposure. Patient admits to some difficulty arising from a seated position as well as fatigue while combing her hair.

Previous Treatment: Patient had been given multiple topical steroids with only minimal relief of the rash and the associated pruritus. Lab work, muscle, and skin biopsy were ordered, as well as follow up with rheumatology in regards to a muscle biopsy.

Other information: Patient had been to multiple physicians prior to coming to our clinic including an internal medicine physician, dermatologist, allergist, rheumatologist, as well as her primary care physician. Patient admits having all normal screening exams such as a mammogram/colonoscopy/pelvic examination as well as a recent CT of her chest, abdomen, and pelvis which didn’t reveal any abnormalities.

Well nourished, healthy appearing female with scaly pink erythematous patches on bilateral upper extremities, post-auricular bilaterally, central chest and anteiror/posterior neck. Patient also had scaly erythema along frontal forehead near her hairline, and violaceous poikiloderma especially of the lateral neck, superior back/neck and chest. She stated previously on her hands she had erythematous papules overlying the metacarpophalangeal joints but this has since resolved.